Aim: To assess and compare the roles of plasma and urine concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis of septic acute kidney injury (AKI) in adult critically ill patients.Methods: Patients were divided into three groups as sepsis-non AKI, sepsis-AKI and non sepsis-non AKI. Plasma samples for NGAL and Cystatin C were determined on admission and on alternate days and urinary samples were collected for every day until ICU discharge.Results: One hundred fifty one patients were studied; 66 in sepsis-non AKI, 63 in sepsis-AKI, 22 in non-sepsis-non-AKI groups. Although plasma NGAL performed less well (AUC 0.44), urinary NGAL showed significant discrimination for AKI diagnosis (AUC 0.80) with a threshold value of 29.5 ng/ml (88% sensitivity, 73% specificity). Both plasma and urine Cystatin C worked well for the diagnosis of AKI (AUC 0.82 and 0.86, thresholds 1.5 and 0.106 mg/L respectively).Conclusion: Plasma and urinary Cystatin C and urinary NGAL are useful markers in predicting AKI in septic critically ill patients. Plasma NGAL raises in patients with sepsis in the absence of AKI and should be used with caution as a marker of AKI in septic ICU patients.

中文翻译：

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血浆和尿液中性粒细胞明胶酶相关脂质运载蛋白 (NGAL) 和胱抑素 C 在危重患者脓毒症急性肾损伤早期诊断中的应用。

目的：评估和比较中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和胱抑素 C 的血浆和尿液浓度在成人危重患者脓毒症急性肾损伤（AKI）早期诊断中的作用。方法：将患者分为三组：脓毒症-非 AKI、脓毒症-AKI 和非脓毒症-非 AKI。NGAL 和胱抑素 C 的血浆样本在入院时和隔天测定，每天收集尿样直至 ICU 出院。结果：研究了 151 名患者；败血症-非 AKI 组 66 例，败血症-AKI 组 63 例，非败血症-非 AKI 组 22 例。尽管血浆 NGAL 表现较差（AUC 0.44），但尿 NGAL 显示出对 AKI 诊断的显着区分（AUC 0.80），阈值为 29.5 ng/ml（88% 敏感性，73% 特异性）。血浆和尿液胱抑素 C 均能很好地诊断 AKI（AUC 0.82 和 0.86，阈值分别为 1.5 和 0.106 mg/L）。结论：血浆和尿胱抑素 C 和尿 NGAL 是预测脓毒症危重患者 AKI 的有用标志物. 血浆 NGAL 在没有 AKI 的脓毒症患者中升高，应谨慎用作脓毒症 ICU 患者的 AKI 标志物。